Determination involves a medical condition which the timeframe for an expedited internal review would seriously jeopardize the life or health of the covered person.

If the adverse determination involves a denial of coverage based on a determination that the recommended or requested health care service or treatment is experimental or investigational and the covered person's treating physician certifies in writing that the recommended or requested health care service or treatment that is the subject of the adverse determination would be significantly less effective if not promptly initiated.